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What is shingles?

Shingles (herpes zoster) is a common viral infection of the nerves. It causes a painful rash or small fluid-filled blisters on an area of skin anywhere on the body, usually on one side. It’s a reactivation of the chickenpox virus. So, if you’ve ever had chickenpox, you can get shingles. That’s because the chickenpox virus stays inactive in your body for many years.

What are risk factors for shingles?

According to the Centers for Disease Control and Prevention (CDC), approximately one out of every three people in the United States will get shingles at some point during their life. Risk factors include:

  • Age. The risk of developing shingles increases with age. Shingles is more common in people over 50. Those over the age of 60 are at higher risk for more severe complications. Anyone can get shingles, although it is rare in children.
  • Some diseases. Diseases, such as HIV/AIDS and cancer can weaken the immune system and increase your risk of shingles. Those who have had an organ transplant or bone marrow transplant are also at increased risk. 
  • Cancer treatments. Immunotherapy, radiation and chemotherapy can damage the immune system and make it harder for the body to fight off infections and diseases, including shingles.
  • Some medications. Drugs that suppress the immune system can increase your risk of shingles. This includes long term use of corticosteroids, such as prednisone, some anti-inflammatory medications, statins and medications that prevent rejection of transplanted organs. 
  • Stress. Both physical and emotional stress can impact your immune system and increase your risk of shingles.

What are the symptoms of shingles?

How do you know if you’re getting shingles? The first symptoms are usually itching, tingling, burning or shooting pain, followed by a rash one to five days later. A clue that it’s shingles, and not something else, is that shingles almost always appears on just one side of the body. The rash is usually on the side of the torso and sometimes on one side of the face or neck. It can also appear in the mouth, although that’s less common.

In addition to these symptoms that affect the skin, some people experience fever, chills, upset stomach or headaches. But less than 20% of people with shingles have these non-skin symptoms.

The rash usually consists of clustered, small, red bumps that may form into blisters and ooze fluid. After one to two weeks, the blisters begin to heal and form scabs. They usually clear up in two to four weeks. However, pain may persist at the site of the rash long after the skin has healed.

View some images of shingles from the CDC.

What can be mistaken for shingles?

It can be easy to mistake shingles for other common skin rashes including:

  • Psoriasis
  • Eczema 
  • Allergic rashes such as hives, poison ivy and contact dermatitis
  • Ringworm
  • Viral infection, such as measles

A very rare condition called Ramsay Hunt syndrome (RHS) is also caused by the reactivation of the varicella zoster virus. RHS affects the facial nerve, which can lead to facial paralysis and damage to the cranial nerve responsible for hearing and balance. RHS is usually diagnosed by looking for signs of weakness in the face and a blister-like rash inside the ear. 

Is shingles dangerous?

Shingles is not usually dangerous to healthy people, but it can cause significant pain during an attack and can result in possible complications. According to the CDC, 10 to 18% of people who get shingles develop long-term nerve pain, called postherpetic neuralgia (PHN). You’re more likely to develop PHN if you’re older. Shingles can also cause complications in the eye that can lead to blindness. It’s rare, but possible, for shingles to cause potential complications including brain inflammation, hearing problems (including hearing loss), pneumonia or death.

Is shingles contagious?

You can’t catch shingles from someone with shingles, but you could catch chickenpox from them. The varicella-zoster virus (VZV) that causes shingles can spread from a person with active shingles to others. You could get chickenpox from it if you have not had chickenpox or the chickenpox vaccine.

People with weakened immune systems, pregnant women and newborns, as well as those who have not had chickenpox or the chickenpox vaccine, should avoid physical contact with someone that has active chickenpox or shingles. 

Someone with shingles cannot spread the virus before the rash appears or after it crusts, and the risk of spreading VZV is low if the rash is covered.

How can you prevent shingles?

Because shingles reactivates the chickenpox virus, anyone who has had chickenpox is a candidate for shingles. The chickenpox vaccine was introduced in 1995, and today, chickenpox is rare. But before then, it was widespread. The CDC reports that over 99% of Americans born on or before 1980 have had chickenpox.

The CDC recommends that healthy adults who are 50 or older get two doses of the recombinant zoster vaccine, known as Shingrix. Adults aged 19 and older with weak immune systems due to disease or therapy should also get vaccinated. Shingrix is highly effective in preventing shingles and the long-term pain that can remain after the rash has healed. 

You should still get the shingles vaccine if you’ve:

  • had shingles (it’s not common, but it’s possible to get it more than once)
  • had the chickenpox vaccine
  • had an older version of the shingles vaccine called Zostavax (which is no longer available in the US)

Common side effects of the shingles vaccine include redness, swelling and pain at the injection site. Some people report muscle pain, tiredness, headache, upset stomach and chills. Symptoms are typically mild to moderate and last one to three days. 

How is shingles diagnosed and treated?

What do you do for shingles? Early treatment for shingles is critical, so consult a physician immediately if you’re concerned you might have it. Your health care provider can usually diagnose shingles based on a report of pain on one side of the body and the appearance of the rash and blisters. 

If you’re diagnosed with shingles, prescription antiviral medications such as acyclovir, valacyclovir and famciclovir can shorten the course of the illness and make symptoms less severe. Treatment is most effective if you take medication as soon as you see a rash appear.

You can treat shingles pain with acetaminophen (Tylenol), ibuprofen (Advil) or naproxen (Aleve). Calamine lotion, an oatmeal bath or a topical cream can help with itch relief. 

Do you need antibiotics for shingles? Not in most cases. Since a virus causes shingles, an antibiotic won’t help. It’s not common, but the shingles rash can become infected. In that case, you would need antibiotics.

If you have developed a painful, blistering rash that is suspicious for shingles, visit your physician or urgent care to confirm the diagnosis and start treatment to relieve your discomfort and reduce the risk of long-term complications.